FEBRUARY 11, 2019
ORLANDO, FL
Meet the Patient as Payor
www.HIMSSConference.org
#rethinkRCM
What we all know
Health system revenue mix has changed
significantly, and the patient is now a key payer.
Patients collectively are a provider’s largest payer
after Medicare and Medicaid, accounting for 20 to
35% of the average health system’s revenue
1
1
Sources from Forbes, McKinsey
Why it matters:
• Consumers pay more slowly
• Consumers struggle to pay
• Consumers pay medical bills last
TIME
PATIENT REVENUE
REVENUE
But these are the
good-times, so there’s
nothing to worry about,
right?
Not everyone is winning
And healthcare costs
have grown significantly
40M
Americans will have received collections
calls in 2018 because of medical debt
What is
happening?
How can we
make this actionable?
How can we help?
National Study Methodology
ONLINE STUDY
1,750 qualified respondents:
• 18+ years old
• Total U.S.
• Representative sample based on age, gender, income and ethnicity
TO QUALIFY:
• Either the respondent or someone in their immediate family must have received
treatment at a hospital, health system or urgent care center in the past year
• Must be the guarantor or acting guarantor of patient in question
The survey showed
some interesting results
The majority of visits are unplanned
What best describes the type of care you received in the last 12 months?
UNPLANNED PLANNED
NEITHER DON'T KNOW
56%
37%
6%
1%
60%
50%
40%
30%
20%
10%
0%
NOT AT ALL
INFLUENTIAL
EXTREMELY
INFLUENTIAL
4%
30%
25%
20%
15%
10%
5%
0%
1%
2%
3%
8%
35%
7%
10%
17%
15%
33%
1 2 3
4 5 6 7 8 9 10
65% indicate that cost
strongly or extremely
strongly influences
satisfaction
On a scale from 1-10, describe how cost influences your
overall satisfaction with a physician or health system
NOT AT ALL
INFLUENTIAL
EXTREMELY
INFLUENTIAL
15%
25%
20%
15%
10%
5%
0%
1 2 3
4 5 6 7 8 9 10
3%
6%
4%
10%
12% 12%
7%
22%
3%
6%
41% indicate strong
risk that rising costs
will jeopardize health
How much do rising healthcare costs influence
your ability or interest in seeking care?
Yet consumers don’t
get cost estimates
No and I
never do
Yes I did
this time
but usually
don’t
6%
30%
25%
20%
15%
10%
5%
0%
35%
15%
12%
31%
36%
Yes I did
this time
but usually
do
No but I
usually do
No and I
rarely do
40%
Regarding your care in the last twelve months,
did you obtain cost estimates for your medical
services prior to receiving care?
Accuracy of bills
60%
50%
40%
30%
20%
10%
0%
70%
Overall cost Ease of paying Ability to finance
80%
74%
65%
54%
44%
(Scale 1-10, Top 3 Box Score)
Consumers care about the financial experience,
and are willing to pay!
Describe how each of the following influences your overall satisfaction with a physician or health system?
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
18-40 YO
41-65 YO
65+ YO
They like to pay online. Not just the younger consumers.
How do you prefer to pay for your medical bills?
How can we improve the
experience?
Alleviate confusion
Transparent dialog and presentation of
cost and payment options
Reduce stress
Empathic and compassionate conversations
Minimize surprises
Proactive outreach throughout the patient care journey,
rather than waiting until after a medical event
Build trust
A consistent experience, regardless of communication
channel (e.g., onsite, online, via phone)
Loyal
Patients
Solo
Strivers
•High interest in
payment plans
•Ethnically diverse
•Lower income
•Higher OOP
balance
•Commercial and
Medicaid plans
•More influenced by
care cost
•More bad debt
•Prefer to hear from
health system via
phone
Seasoned &
Receptive
•High interest in
payment plans
•Lower income
•Married, empty
nesters, own home
•Higher OOP
balance
•More Medicare,
some HDHP
•Higher interest in
communication by
mail
Overextended
Achievers
•Moderate interest in
payment plans
•Higher income
•Married
•Higher OOP
balance
•Mostly commercial
insurance, many
HDHP
•Higher credit card
balances
•Digitally savvy
Hearty &
Carefree
•Not interested in
payment plans
•Lowest income
•Higher female,
single, some with 1-
2 kids
•Low OOP balance
•Highest Medicaid,
less HDHP
•Ethnically diverse
•Digitally savvy
Self-Sufficient
Sages
•Not interested in
payment plans
•Older, higher
Caucasian
•Higher income
•Married, empty
nesters
•Lower OOP
balances
•Mix of commercial
and Medicare, lower
deductibles
Movement between segments as OOP balances shift, Insurance plans change, medical conditions arise
Note: Terms higher/lower, more/less are used in reference to survey population averages
National Patient Segments
Solo
Strivers
Proactive
Outreach by
Phone
Eligibility, cost
estimates,
tailored
payment options
3 years,
$50/month, no
interest
Seasoned &
Receptive
Letter via mail
Eligibility, cost
estimates,
tailored
payment options
1 year,
$200/month, 3%
interest
Overextended
Achievers
Email
or text
Cost estimates,
tailored
payment options
2 years,
$100/month,
6% interest
Hearty &
Carefree
Email and
website
General
information
about financial
services
Online payment,
text to pay
Self-
Sufficient
Sages
Bill and/or other
mailer
General
information
about financial
services
Online payment
Use Cases
Journey of Solo Strivers
•Information about
financial plans, how
wellness can save
money
•Instagram, mailers and
in-person seminars
Preventive
Care
•Conversation in—
person at appointment
•Charity care eligibility,
cost estimates,
payment options,
platform sign-up
Diagnosis
•Proactive outreach by
phone when they’re
home
•Actual costs and OOP
balances, answer any
questions
Treatment
•Email with text
reminders, payment
online
•Phone calls, if not
paying
Recovery
Getting Started
Three steps to move from collections
strategies to engagement strategies
STEP 1:
Understand consumer needs and preferences when dealing with healthcare
finances, and group patients into manageable segments with similar behaviors.
STEP 2:
Link segments with health system data to create localized and actionable
engagement strategies.
STEP 3:
Activate and test strategies in and around
a patient financial health platform.
www.HIMSSConference.org
#rethinkRCM
Thank you.
@VisitPay
